Atwell Thomas D, Vlaminck Jay J, Boorjian Stephen A, Kurup Anil N, Callstrom Matthew R, Weisbrod Adam J, Lohse Christine M, Hartman William R, Stockland Andrew H, Leibovich Bradley C, Schmit Grant D, Thompson Robert H
Departments of Radiology, Mayo Clinic, Mayo Building, E2, 200 First St. SW, Rochester, MN 55905..
Departments of Radiology, Mayo Clinic, Mayo Building, E2, 200 First St. SW, Rochester, MN 55905.
J Vasc Interv Radiol. 2015 Jun;26(6):792-9. doi: 10.1016/j.jvir.2015.02.010. Epub 2015 Mar 29.
To describe the technical methods, safety, and local tumor control rate associated with percutaneous cryoablation of stage T1b renal cell carcinoma (RCC).
A retrospective review of a percutaneous renal ablation registry was used to identify 46 patients with a total of 46 biopsy-proven RCC lesions measuring 4.1-7.0 cm treated with cryoablation between 2003 and 2011. The main outcome parameters investigated were adjunctive maneuvers, complications, and local tumor progression, and cancer-specific survival rates. Complication rates were categorized and recorded using the Clavien-Dindo classification system. Progression-free and cancer-specific survival rates were estimated using the Kaplan-Meier method.
The mean treated RCC size was 4.8 cm (range, 4.1-6.4 cm). Prophylactic tumor embolization was performed in 7 patients (15%), ipsilateral ureteral stents were placed in 7 patients (15%), and hydrodisplacement of bowel was performed in the treatment of 16 tumors (35%). A single technical failure (2.2%) was observed at the time of ablation. Thirty-six tumors (78%) had follow-up imaging at 3 months or later following ablation, including a single recurrence at 9 months after ablation. The mean duration of follow-up for the 35 RCC tumors that did not recur was 2.0 years (range, 0.3-6.1 y). Estimated local progression-free survival rate at 3 years was 96.4%. Of the 46 cryoablation procedures, there were 7 complications (15.2%) of grade II or worse.
The results suggest that cryoablation represents a valid treatment alternative for select patients with clinical stage T1b RCC. Complications are frequent enough that multidisciplinary patient management should be considered.
描述经皮冷冻消融治疗T1b期肾细胞癌（RCC）的技术方法、安全性及局部肿瘤控制率。
对经皮肾消融登记处进行回顾性研究，以确定2003年至2011年间46例经活检证实的RCC患者，共46个病灶，大小为4.1 - 7.0 cm，接受了冷冻消融治疗。研究的主要结局参数包括辅助操作、并发症、局部肿瘤进展及癌症特异性生存率。并发症发生率采用Clavien-Dindo分类系统进行分类和记录。无进展生存率和癌症特异性生存率采用Kaplan-Meier法估算。
治疗的RCC平均大小为4.8 cm（范围4.1 - 6.4 cm）。7例患者（15%）进行了预防性肿瘤栓塞，7例患者（15%）放置了同侧输尿管支架，16个肿瘤（35%）在治疗时进行了肠管水分离。消融时观察到1例技术失败（2.2%）。36个肿瘤（78%）在消融后3个月或更晚进行了随访成像，包括消融后9个月出现1例复发。35个未复发的RCC肿瘤平均随访时间为2.0年（范围0.3 - 6.1年）。3年时估计的局部无进展生存率为96.4%。46例冷冻消融手术中，有7例（15.2%）发生II级或更严重的并发症。
结果表明，冷冻消融是部分临床T1b期RCC患者的有效治疗选择。并发症发生率较高，应考虑多学科患者管理。
